Physical Therapy Program In Patients Research Articles

MODERN VIEWS OF USE OF TELEREHABILITATION IN URINARY TRACT DYSFUNCTION IN PATIENTS WITH MULTIPLE SCLEROSIS

Multiple sclerosis is a chronic disease of the nervous system that often leads to various disorders, including urinary tract dysfunction. This significantly affects the quality of life of patients, causing physical and psychological complications. The term "bladder rehabilitation" summarizes treatment options aimed at restoring its function in patients with neurourological symptoms. A strong contraction of the sphincter of the urethra and/or pelvic floor, as well as anal dilatation, manipulation of the genital area, and physical activity reflexly inhibit urination. A comprehensive physical therapy program for patients with pelvic disoders includes pelvic floor vibration massage, training in proper breathing patterns, pelvic floor muscle relaxation and stabilization exercises and should last several months, during which the patient regularly visits the doctor. The pandemic and war have created barriers that affect almost every aspect of life, treatment and rehabilitation, especially for people with chronic neurological conditions. Traditional rehabilitation methods used to correct urinary tract dysfunction have their limitations, including difficulties in accessing specialists, especially in remote areas. This stimulates the development and implementation of telerehabilitation as an alternative approach. Telerehabilitation involves the use of digital technologies for the remote provision of medical services and patient monitoring. It allows doctors to monitor the condition of patients, provide recommendations and adjust treatment without the need for personal visits. Considering the existing data and our own clinical experience, we consider it appropriate to use telerehabilitation for the correction of disorders of the lower urinary tract, especially in the conditions of war, when access to rehabilitation centers may be difficult. In the department of medical rehabilitation of the University Clinic of the Kharkiv National Medical University, we successfully conducted telerehabilitation using Google Meet video conferencing for 10 patients with urinary incontinence on the background of multiple sclerosis, whose EDSS was no more than 4.0. When conducting online classes under the guidance of a physical therapist, patients noted a desire to strictly follow the recommendations and perform regular exercises. All patients kept a urination diary, according to which the frequency of urination was reduced by an average of 20-25%, which had a positive effect on their quality of life. Although our observations are not representative, in combination with existing studies, we consider telerehabilitation to be a promising direction in complex therapy and rehabilitation of this pathology. Conclusion The use of telerehabilitation for urinary tract dysfunction in patients with multiple sclerosis is a promising direction that requires further research. This approach can significantly improve the quality of life of patients, reduce the burden on the health care system and provide a more affordable and convenient treatment. A multidisciplinary team should be involved, including a neurologist, a urologist, a gynecologist, and a physical therapist to select the optimal tactics of drug treatment and physical therapy. A promising direction of further research is the development of standard protocols for conducting telerehabilitation for patients with lower urinary tract dysfunction against the background of multiple sclerosis and other pathologies.

PHYSICAL REHABILITATION OF DISABLED PEOPLE WHO HAVE SUFFERED A STROKE (EARLY PERIOD)

The aim - is to increase the effectiveness of the physical therapy program for patients with the consequences of a hemorrhagic stroke with the help of differentiated application of rehabilitation measures depending on the severity of the neurological disorder and concomitant diseases. Materials and methods. 100 patients were observed in the neurorehabilitation center of the Ivano-Frankivsk Regional Clinical Hospital. (50 men and 50 women, average age 63.57 ± 0.43 years) in the early post-stroke recovery period. All patients were clinically and neurologically examined according to a specially developed protocol according to modern scales - NIHSS, mRS on the 10th, 30th, 90th and 180th day of the disease and differentiated treatment in accordance with the standards and protocols of care for patients who have suffered a stroke. The patients were divided into four groups of 25 patients each. The first group included patients with hemorrhagic stroke, among whom the severity of post-stroke disorders was mild (NIHSS score ≤ 7 points), without concomitant diseases. The second group consisted of patients with a mild degree of post-stroke disorders (NIHSS score ≤7 points) and concomitant pathology (heart pathology, diabetes, chronic obstructive pulmonary disease of the II stage). The third group included patients with intracerebral stroke, among whom the severity of post-stroke disorders was moderate and obvious (NIHSS score > 7 points), without concomitant pathology. The fourth group consisted of patients with moderate severity of post-stroke disorders (NIHSS status > 7 points) and accompanying pathology. A statistical analysis of the use of descriptive statistics methods was carried out. The relationship between qualitative features was assessed using the χ2Pearson test. The results. According to the results of treatment, among the patients of group I, 20 patients (80.0%) (mRS index 0–2) had a favorable course. In group I, a relatively favorable result (mRS index ≥3 points) was achieved only in 5 patients (20.0%); in the II group, a positive result was achieved in 17 patients (72.0%), a relatively favorable result was achieved in 8 (28.0%); in group III - a favorable result was achieved in 15 patients (60.0%), relatively favorable - in 10 (40.0%), and in group IV - a favorable result was found only in 14 patients (56.0%), relatively favorable – in 11 (44.0%).
 Conclusions. The assessment of the functional state of disabled people in the early period of a stroke made it possible to establish that the basis of their low motor activity lies in: walking disorders (41% of disabled people), balance functions (35.9%), a decrease in the strength and endurance indicators of muscle groups that have preserved their functionality, low level of adaptive potential of the circulatory system (56.4%), dysregulation of neuropsychological processes
 Differentiated application of the program of rehabilitation and physical therapy in post-stroke patients in different groups, taking into account the severity of neurological disorders of the recovery period and the selection of methods and methods of treatment, leads to a significant increase in the effectiveness of rehabilitation measures.

Features of building physical therapy programs to improve mobility in the cervical-thoracic spine

the article discusses the peculiarities of developing physical therapy programs to improve mobility in the cervical-thoracic spine. The author examines the relationship between neck pain and thoracic spine conditions, providing approaches to effectively reduce pain and increase mobility. The article reveals specific methods and tools that contribute not only to pain relief but also to active restoration of mobility in both parts of the spine. The author takes into account the individual characteristics of patients, offering a personalized approach to the physical therapy program. The proposed methodology helps to improve the general condition of the body, psycho-emotional state, mobility in the thoracic spine, and reduce pain in the neck, shoulder girdle, and thoracic spine. In order to evaluate the effectiveness of the developed physical therapy program for patients with neck pain and impaired mobility of the thoracic spine (kyphotic posture), a study was conducted on 5 patients who were observed at the Institute of Vertebrology and Rehabilitation clinic in Kyiv. Kyiv.

Dynamics of parameters of autonomic nervous system functioning and psychoemotional status as a criterion for the effectiveness of the physical therapy program for patients with bruxism

Dynamics of parameters of autonomic nervous system functioning and psychoemotional status as a criterion for the effectiveness of the physical therapy program for patients with bruxism

Підготовка майбутніх фізичних терапевтів до складання програми фізичної терапії для дітей середнього шкільного віку з хворобою Літтла

The article revealed the issue of professional training of future physical therapists for the preparation of a physical therapy program for middle school children with Little's disease, where it was taken into account that each patient had an individual physical therapy program according to the patient's categorical profile of the ICF, selected research methods and determined physical therapy methods. The purpose of the study was to analyze the preparation for the development of a program of physical therapy for children of secondary school age with Little's disease, which future physical therapists will be able to use in their professional activities. The physical therapy program was developed for a boy, 11 years old, who has the main diagnosis: Little's disease, concomitant diseases: mild mental retardation, valgus deformity of the lower limbs, congenital. A categorical profile was determined according to the short basic set of ICF DP for a child of middle school age (11 years) with Little's disease (spastic diplegia). The physical therapy program included the following methods: therapeutic exercises, mobility training and walking with aids, massage, training on an exercise bike and a home program (fitball exercises to relax muscles, improve balance, gymnastic exercises to increase muscle strength of the upper limbs, improving posture, exercises to improve the mobility of the joints of the lower extremities, strengthening the skills of standing and walking with a walker, games and gymnastics for the fingers (development of the manipulative function of the hands), treatment of position). The study showed that in order to draw up a physical therapy program for patients with Little's disease, it is necessary to determine the research methods, obtain the initial data based on them, compile a categorical profile of the patient according to the ICF, and choose physical therapy methods and their dosage according to the obtained results.

The Use of Fissios App© as a Complement to a Face-to-Face Respiratory Physiotherapy Program versus an Attendance-Only Face-to-Face Physiotherapy Program in Patients Scheduled for Thoracic Surgical Procedures Reduces the Risk of Developing Postoperative Pulmonary Complications-A Quasi-Experimental Study.

Postoperative pulmonary complications (PPCs) increase the hospital length of stay (LOS) and the cost of healthcare associated with surgical procedures. Strategies to reduce PPCs begin before surgery and continue in the postoperative period. Fissios App© is a smartphone application that contains perioperative medical advice and a structured respiratory physiotherapy program. The objective was to implement the use of this app in a group of patients scheduled for a thoracic surgical procedure and determine its efficacy in reducing PPCs. This was a quasi-experimental study in which all patients attended a face-to-face respiratory physiotherapy program, and the intervention group used Fissios App© as a complement. We prospectively recorded the postoperative evolution of both groups, analyzed the categorical differences and quantitative variables, and created a binary logistic regression model. We recruited 393 patients (131 intervention and 262 control). The intervention group had a lower incidence of PPCs (12.2% versus 24% in the control group, p = 0.006), a shorter LOS (a median of 3 days (IQR = 2-5) versus 4 days (IQR = 3-6, p = 0.001) in the control group), and a reduction in the risk of developing PPCs by 63.5% (OR: 0.365, 95% CI: 0.17-0.78). The use of Fissios App© improved the clinical outcomes after surgery and reduced the probability of developing PPCs.

The effectiveness of the physical therapy program for patients with metabolic syndrome based on the study of the dynamics of the functional state of the autonomic nervous system and hemodynamic parameters

Purpose: determination of the influence of the physical therapy program on the dynamics of blood pressure, heart rate and vegetative Kerdo index in patients with metabolic syndrome. Material & Methods: the study was conducted on the basis of the Municipal institution of health care "Kharkiv City Hospital No. 3". 28 young women were under observation, randomly divided into two groups: the main group (MG) – 14 patients and the control group (CG) – 14 patients. The mean age of patients in the MG was 31,49±0,71 years, in the CG – 31,06±0,57 years. The patients of the main group underwent rehabilitation measures according to the author's program of physical therapy, which included a hypocaloric diet with a lipid-lowering orientation (lipid-lowering diet No. 1), the basic principles of which are developed by the American Heart Association, therapeutic massage for patients with alimentary-constitutional obesity; kinesitherapy using elements of sports-oriented aerobics and special physical exercises based on Pilates gymnastics using fitballs and expanders; dosed walking in combination with breathing exercises, taking into account the activity of the autonomic nervous system, for patients in the control group – according to the program used for metabolic syndrome in the indicated medical institution. To identify the effectiveness of the author's program, a comparison was made of heart rate, arterial tonometry, vegetative Kerdo index (V.I.) at the beginning and end of the study. Results: in the determination and analysis of blood pressure, heart rate and vegetative Kerdo index during the second study, we noted the normalization of heart rate, SBP, DBP in women of the main group (р>0,05), in the control group, the dynamics of DBP was statistically insignificant (р>0,05). In women of the main group, the heart rate during the second examination compared with the primary one decreased by 19,8%, the SBP level decreased by 9,1%, the DBP level decreased by 11,0%. In CG patients, the heart rate during the second study decreased by 8.8% compared to the primary one, the SBP level decreased by 5,2%, the DBP level decreased by 3,9% (р>0,05). Conclusions: comparison of the obtained results of the study showed the normalization of hemodynamic parameters and the tone of the autonomic nervous system, there was also a tendency towards balance of the sympathetic and parasympathetic divisions of the ANS in patients of the main group, in the physical rehabilitation of which therapeutic exercises were applied with the use of regulated breathing exercises, taking into account the tone of the sympathetic or parasympathetic divisions of the autonomic nervous system, which helps to improve the quality of life of patients with metabolic syndrome.

Peculiarities of using yoga therapy and kinesiotaping in physical therapy of patients with ankylosing spondylitis


 
 
 numerous publications indicate that the quality of life of patients with ankylosing spondy- litis (AS) is poor due to a combination of symptoms that limit the functional abilities of patients: stiff- ness of movements (91% of patients), pain (82%), increased fatigue (61%), poor sleep (55%), anxiety about the future (51%). The aforementioned characteristics of ankylosing spondylitis account for a high incidence of permanent disability, ranging from 24% to 81% [1]. This disease is currently incurable, but ankylosing spondylitis and its destructive effects on the spinal column can be slowed by methodsand means of physical therapy, maintaining the mobility of the spine and joints and avoiding further progression of the disease. One such means of physical therapy is yoga therapy and kinesiotaping, whose effectiveness has been proven in this study. The article deals with the main problems of spinal mobility in patients with ankylosing spondylitis and presents the methodology of physical rehabilitation for this contingent of patients in the post-hospital period, which is developed by adding yoga therapy and kinesiotaping to the classical physical therapy program of patients with ankylosing spondylitis. The proposed methodology helps to slow down the progression of this pathology, maintain mobility in allparts of the spinal column, reduce pain syndrome and morning stiffness in the lumbar spine. In order to evaluate the effectiveness of the developed physical therapy program for patients with ankylosing spondylitis, a study of 8 patients was carried out and observed at the medical center of physical reha- bilitation «Algorithm Health» in Kiev.
 
 

DİZ OSTEOARTRİTİ OLAN HASTALARDA BALNEOTERAPİNİN ERKEN DÖNEM ETKİNLİĞİNİN DEĞERLENDİRİLMESİ

OBJECTIVE: Balneotherapy is a non-pharmacological method recommended and used in knee osteoarthritis. The aim of this study is to evaluate the early-term effectiveness of the physical therapy program applied together with balneotherapy in patients with knee osteoarthritis. MATERIAL AND METHODS: Sixty patients diagnosed with primary knee osteoarthritis were included in the study. Randomization was carried out as a balneotherapy group (n=30) and a control group (n =30) by simple randomization method. In Both groups, all of the patients were treated with a fifteen sessions physical therapy program consisting of a hot pack, transcutaneous electrical stimulation, and ultrasound (1 MHz, 1,5 Watt/cm2). Patients in the balneotherapy group were also treated for fifteen sessions balneotherapy program lasting 20 min/day in addition to the physical therapy program. Patients were assessed by Visual Analogue Scale (VAS), WOMAC, and isokinetic muscle testing at the beginning and end of the therapies. RESULTS: A statistically significant improvement was observed in the mean scores of VAS, all WOMAC scores, and isokinetic test measurements after treatment in both groups (p<0.001). Comparison of the groups by percent changes showed that; VAS (p=0.047), WOMAC pain (p=0.002), WOMAC stiffness (p=0.004), WOMAC function (p=0.001), WOMAC total (p=0.001) differed significantly in favor of balneotherapy group, no significant difference was found in isokinetic muscle strength measurements (p>0.05). CONCLUSIONS: Balneotherapy combined with a physical therapy program in patients with knee osteoarthritis is effective in reducing pain and increasing physical function in the early period.

Dynamics of hemodynamic parameters and tone of the autonomic nervous system in the rehabilitation of patients with neurocirculatory dystonia

Purpose: to substantiate, develop and evaluate the effectiveness of a physical therapy program for young women with hypertensive neurocirculatory dystonia at the outpatient stage. Material & Methods: under our supervision there were 28 women with a diagnosis of neurocirculatory dystonia of hypertonic type; they were randomly divided into two groups: main (14 patients) and control (14 patients); the average age of patients in the main group was 20,1±0,35 years, in the control group – 20,6±0,23 years. The course of physical therapy for patients of the main and control groups lasted for 5 months. The patients of the main group underwent rehabilitation measures according to the program of physical therapy, which included kinesiotherapy using therapeutic exercises based on dance aerobics in combination with regulated breathing exercises, taking into account the tone of the ANS and autogenic training, patients of the control group were engaged in the E.V. Doliger physical therapy program for patients with NCD. Results: the functional indicators of the cardiovascular and autonomic nervous system obtained during the primary study indicated the absence of economization of the work of the cardiovascular system, the presence of dysfunction of the autonomic nervous system in the direction of the predominance of the activity of the sympathetic department. After 5 months of using physical therapy programs, when re-examined, patients in both groups showed a decrease in heart rate and a decrease in blood pressure; stroke volume in the main group was within normal limits, in the control group, a decrease in stroke volume indicated a reduced myocardial contractility; the decrease in the minute volume of blood in the main group was due to a decrease in heart rate, in the control group – due to a decrease in heart rate and stroke volume. The value of the Kerdo index in the main group corresponded to the state of eutonia, in the control group – sympathicotonia. Conclusions: in the course of the study, we came to the conclusion that a physical therapy program was developed, which included kinesitherapy using therapeutic exercises based on dance aerobics in combination with regulated breathing exercises, taking into account the tone of the parasympathetic and sympathetic divisions of the autonomic nervous system and autogenic training, is effective and contributes to the normalization of hemodynamic parameters and the tone of the autonomic nervous system, which improves the quality of life of NCD patients. The conducted studies have confirmed the need for the use of physical therapy, including kinesitherapy using therapeutic exercises based on dance aerobics in combination with regulated breathing exercises, taking into account the tone of the ANS and autogenous training.

Rehabilitation of Patients with the Consequences of Ischemic Stroke Via the Means of Exercises of Physical Therapy

Aim: The aim is to elaborate a physical therapy program for patients affected by ischemic stroke and prove its usability. Materials and Methods: Comparative analysis of motor activity indicators obtained by diagnosing and monitoring the functional state of ischemic stroke patients using clinical tools. The participants of the experiment are male patients aged between 50-71 years affected by an ischemic stroke. Results: Elaborated on ischemic stroke physical therapy constitutes the set of therapeutic programs for the period of rehabilitation of patients affected by ischemic stroke, which is realized gradually and consists of 3 components: therapeutic exercises, electric stimulation of one’s shoulders and psychological assistance. As a result of the application of the authorial physical therapy program for patients affected by ischemic stroke, there is the occurrence of positive changes in the functional and psychological state of the patients. Experimental data was verified by the comparison of the level of motional activity of the patient before the implementation of a physical therapy program for the patients affected by ischemic stroke, as well as after scientific research. Conclusions: The usability of physical therapy programs for patients affected by ischemic stroke is statistically proven with the positive shifting of the functional state of the patients.

Evaluation of the results of pH-metry of the stomach in patients with peptic ulcer of the stomach and duodenum under the influence of a physical therapy program

Purpose: to investigate and evaluate the secretory function of the stomach in patients with peptic ulcer of the stomach and duodenum under the influence of the use of a physical therapy program. Material & Methods: 30 men aged 36 to 45 years were under observation with a diagnosis of peptic ulcer, inactive phase; cicatricial and ulcerative deformity of the duodenal bulb; increased secretory function of the stomach, they were randomly divided into two groups: the main group (MG) – 15 patients and the control group (CG) – 15 patients. The average age of patients MG was 41,5±0,1 years, CG – 42,1±0,2 years. Patients of the main and control groups, patients with peptic ulcer of the stomach and duodenum, underwent a course of physical therapy for 4 months. In the main group, patients were trained according to the developed program of physical therapy, which is based on the use of morning hygienic exercises, kinesiotherapy and self-study with the use of general developmental physical exercises, corrective exercises for the spine and breathing exercises performed at rest; therapeutic massage according to the method of P.B. Efimenko; diet therapy. Patients of the control group were engaged in the program of physical therapy used in medical institutions according to Parkhotik, I. (2003). Results: in the initial study, the results of pH-metry of the stomach in patients of both groups did not differ significantly, that is, the phenomena of hyperacidity in combination with continuous acid formation prevailed. After the application of the physical therapy program in the main group according to the author's program, the indicators significantly improved compared to the control group: normalization of the acid-forming function of the stomach on an empty stomach and stimulated was observed, in addition, normal acidity on an empty stomach occurred in 100% of patients. Conclusions: in the course of the study of the results of pH-metry of the stomach, the effectiveness of the physical therapy program for patients with dissecretory syndrome in gastric and duodenal ulcers was determined and it was concluded that the developed and applied physical therapy program is effective and contributes to a more stable normalization of the stomach, reduction of clinical manifestations of the disease. The conducted studies confirmed the expediency of using physical therapy in patients with this pathology, depending on the clinical manifestations of the disease, indicators of the secretory function of the stomach.

The Use of Scoring Hip Osteoarthritis with MRI as an Assessment Tool for Physiotherapeutic Treatment in Patients with Osteoarthritis of the Hip.

Rehabilitation programs are considered effective at reducing the impact of osteoarthritis (OA) of the hip; however, studies using reliable measures related to OA biomarkers to assess the effects of rehabilitation are lacking. The objective of this study was to investigate whether an MRI-based (Magnetic Resonance Imaging-based), semi-quantitative system for an OA severity assessment is feasible for the evaluation of the structural changes in the joint observed during a long-term physiotherapy program in patients with hip OA. The study group consisted of 37 adult OA patients who participated in a 12-month physiotherapy program. The Scoring hip osteoarthritis with MRI (SHOMRI) system was used to evaluate the severity of structural changes related to hip OA. Hip disability and the osteoarthritis outcome score (HOOS) and the core set of performance-based tests recommended by Osteoarthritis Research Society International were used for functional assessment. SHOMRI showed excellent inter- and intra-rater agreement, proving to be a reliable method for the evaluation of hip abnormalities. At the 12-month follow-up no statistically significant changes were observed within the hip joint; however, a trend of structural progression was detected. There was a negative correlation between most of the SHOMRI and HOOS subscales at baseline and the 12-month follow-up. Although SHOMRI provides a reliable assessment of the hip joint in patients with OA it showed a limited value in detecting significant changes over time in the patients receiving physiotherapy over a 12-month period.

Comparison of the Supervised and Home-Based Physiotherapy Program in Patients with Lateral Epicondylitis

Objective: This study aimed to compare the effectiveness of a supervised and home-based physiotherapy program in the reduction of pain and in improving functional status and quality of life in patients with lateral epicondylitis. Method: Patients diagnosed with lateral epicondylitis and referred to the physiotherapy clinic were evaluated retrospectively. A total of 32 patients were separated into two groups as supervised and home-based physiotherapy groups. All the patients received standard physiotherapy program consisting of static stretching exercises of the ECRB tendon, eccentric exercises of the wrist extensors and cold application, for 3 weeks. The groups were compared in terms of pain severity, range of motion, functional status (Quick-DASH) and quality of life (SF-36) after treatment. Results: Fifteen patients (12 females, 3 males) with a mean age of 44.20±7.35 years were included in the supervised physiotherapy group, and 17 patients (15 females, 2 males) with a mean age of 48.65±12.33 years in the home-based physiotherapy group. There was no statistically significant difference in activity (p=0.980) and rest pain (p=0.483), wrist flexion (p=0.775) and extension (p=0.838) range of motion, functionality (p=0.346) and quality of life (p=0.923) between groups. Conclusion: Patients participating in a home-based physiotherapy program had similar clinical outcomes in terms of pain intensity, range of motion, functionality, and quality of life as patients participating in a supervised physiotherapy. Further prospective randomized studies can be conducted by increasing the sample size and comparing with cost analyzes to determine the rehabilitation regimen that will provide the best outcomes in lateral epicondylitis rehabilitation.

Effect of extracorporeal shock wave therapy on pain intensity, functional abilities, and trunk range of motion in patients with chronic lumbar disc prolapse: A randomized clinical trial

Objectives. This research aimed to assess the impact of extracorporeal shock wave therapy (ESWT) on pain severity, functional abilities, and trunk range of motion in patients with lumbar disc prolapse (LDP). Methods. Design of study was randomized clinical study. Forty male patients had disc prolapse at L5–S1 spine segment with chronic pain. Patients have been randomly divided to two equal groups. The patients in study group received extracorporeal shock wave therapy (ESWT) in addition to conventional physical therapy program. Patients in control group were treated with the conventional physical therapy program which composed of electrotherapy using TENS (15 minutes) and exercise program. Visual analogue scale (VAS) was used to evaluate pain. Functional disability was evaluated by Oswestry disability index (ODI). The Back range of motion device (BROM) has been utilized to measure trunk motion (flexion, extension, side bending, external and internal rotation). For all patients prior to and after six weeks of the therapy program, all outcome measures were evaluated. Results. In the research and control groups, there was a substantial reduction in post-treatment VAS and ODI as compared to pre-therapy (p > 0.001). In both groups, there was a substantial increase in post-therapy ROM compared to pre-therapy (p > 0.001). The comparison among the study and post-therapy control groups showed a substantial decrease in the study group’s VAS and ODI relative to the control group (p > 0.001). There was also a substantial increase in the study group’s trunk flexion, extension, and rotation relative to that of the control group (p > 0.01). Conclusion. The ESWT had a significant analgesic effect and improved functional abilities relative to the conventional physiotherapy program in patients with LDP. Also ESWT had substantial enhancements in trunk ROM relative to conventional physiotherapy.

Functional outcomes after physiotherapy program in patients with massive and irreparable rotator cuff tear

ObjectiveTo evaluate the short term and 1-year follow-up functional effects of a physiotherapy programme in patients over 60 years of age with massive and irreparable Rotator Cuff (RC) tear. MethodsA total of 96 patients with massive and irreparable RC tear were prospectively recruited. All patients were treated with a 12-week physiotherapy programme. Three evaluations were performed, at the beginning, at the end of the treatment and at one year of follow-up. The Constant–Murley questionnaire was used to assess shoulder function, the DASH questionnaire for upper limb function, and the Visual Analogue Scale (VAS) for pain intensity. ResultsAt the end of the treatment, all the variables showed a clinically and statistically significant difference (p<.05). At one year of follow-up, the Constant–Murley showed an increase of 26.5 points (Cohen's d=1.7; 95% CI: 23.5–29.5; p<.001), DASH showed a decrease of 31.4 points (Cohen's d=2.2; 95% CI: 28.5–34.3; p<.001), and the VAS showed a decrease of 3.9cm (Cohen's d=3.6; 95% CI: 3.6–4.1; p<.001). ConclusionIn the short term and 1-year follow-up, a physiotherapy programme showed clinically and statistically significant results in all functional variables in patients older than 60 years with massive and irreparable RC tear.

Resultados funcionales de un programa de fisioterapia en pacientes con rotura masiva e irreparable del manguito rotador

ObjectiveTo evaluate the short term and 1-year follow-up functional effects of a physiotherapy program in patients over 60 years of age with massive and irreparable Rotator Cuff (RC) tear. MethodsA total of 96 patients with massive and irreparable RC tear were prospectively recruited. All patients were treated with a 12-week physiotherapy program. Three evaluations were performed, at the beginning, at the end of the treatment and at one year of follow-up. The Constant-Murley questionnaire was used to assess shoulder function, the DASH questionnaire for upper limb function, and the Visual Analogue Scale (VAS) for pain intensity. ResultsAt the end of the treatment, all the variables showed a clinically and statistically significant difference (p < 0.05). At one year of follow-up, the Constant-Murley showed an increase of 26.5 points (Cohen's d = 1.7; 95% CI 23.5 to 29.5; p < 0.001), DASH showed a decrease of 31.4 points (Cohen's d = 2.2; 95% CI 28.5 to 34.3; p < 0.001), and the VAS showed a decrease of 3.9 cm (Cohen's d = 3.6; 95% CI 3.6 to 4.1; p < 0.001). ConclusionIn the short term and 1-year follow-up, a physiotherapy program showed clinically and statistically significant results in all functional variables in patients older than 60 years with massive and irreparable RC tear.

The Benefit of Perineural Injection Treatment with Dextrose for Treatment of Chondromalacia Patella in Participants Receiving Home Physical Therapy: A Pilot Randomized Clinical Trial.

Introduction: Chondromalacia patella is the degeneration of articular cartilage on the posterior facet of the patella and may indicate the onset of osteoarthritis. Conservative management is the main treatment option, and surgical intervention is considered the last option in a small percentage of patients. Perineural Injection Treatment (PIT) is a recently developed treatment option that is directed adjacent to the peripheral nerves that are the source of pathology causing neurogenic inflammation and pain. Objective: The objective of this study was to evaluate the efficacy of PIT combined with a home physical therapy program in patients with a diagnosis of chondromalacia patella compared with a control group receiving physical therapy only. Methods: Two patient groups were involved in this randomized clinical trial. The first received PIT combined with physical therapy (PIT + PT group) and the second was managed with physical therapy alone (PT group). Both groups were indicated to follow a 6-week home therapy plan afterward. The Western Ontario and McMaster Osteoarthritis Index was used to assess the patients at baseline and 6 months after therapy interventions. Results: Fifty patients (38 women and 12 men, median age 54.7 ± 14.8 years) were included; sex distribution and age did not differ between groups. Both groups had chondromalacia grade II or III, but the degree of gonarthrosis did not differ significantly between groups. The PIT + PT group outperformed PT group for pain (7.3 ± 3.5 vs. 3.2 ± 2.9 points; p < 0.010), stiffness (3 ± 1.69 vs. 1.6 ± 1.5 points; p < 0.010), and functional capacity (23.2 ± 10.7 vs. 11.1 ± 8.9 points; p < 0.010). Conclusions: Compared with physical therapy alone, PIT plus physical therapy reduced pain and stiffness and restored functional capacity. ClinicalTrials.gov Register Number #NCT03515720.

Results of a self-management program added to standard physical therapy in chronic neck pain

ObjectiveTo evaluate the effectiveness of a self-management treatment added to a physical therapy program compared to a physical therapy program in patients with chronic neck pain. MethodsFifty-three patients with chronic neck pain were randomly allocated to a physical therapy intervention (control group) or an individualized self-management combined with physical therapy intervention (experimental group). Both interventions were developed over a four-week period. Outcome measures included were Disability, Fear-Avoidance Beliefs, Health-Related Quality of Life, Pain, and Anxiety and Depression. All outcomes were measured before and after the treatment and at three-month follow-up. ResultsThere were not significant differences between groups at baseline. After the intervention both groups obtained better results in the Neck Disability Index but there were not significant differences between them (p > 0.05). At follow-up, the self-management group obtained significant better results compared to the control group (95 % CI: -5.20(-6.8 to -1.5), p = 0.032). ConclusionsAn individualized self-management program added to a physical therapy program led to a greater improvement in disability at 3 months follow up compared to a physical therapy program alone. Catastrophizing, pain, and health-related quality of life improved significantly after the intervention and at follow-up compared to the standard care alone. Practical implicationsThis study indicates that physical therapy for patients with chronic neck pain preferably should include self-management education.

Feasibility and outcomes of a goal-directed physical therapy program for patients with metastatic breast cancer.

To evaluate the feasibility and outcomes of a tailored, goal-directed, and exercise-based physical therapy program for patients with metastatic breast cancer (MBC). This was an observational, uncontrolled feasibility study. The physical therapy intervention was highly tailored to the individual patient's goals, abilities, and preferences and could include functional, strength, aerobic, and relaxation exercises. Feasibility outcomes were participation rate (expected: 25%), safety, and adherence (percentage of attended sessions relative to scheduled sessions). Additional outcomes were goal attainment, self-reported physical functioning, fatigue, health-related quality of life, and patient and physical therapist satisfaction with the program. Fifty-five patients (estimated participation rate: 34%) were enrolled. Three patients did not start the intervention due to early disease progression. An additional 22 patients discontinued the program prematurely, mainly due to disease progression. Median intervention adherence was 90% and no major intervention-related adverse events occurred. A goal attainment score was available for 42 patients (of whom 29 had completed the program and 13 had prematurely dropped out). Twenty-two (52%) of these patients achieved their main goal fully or largely and an additional 15 patients (36%) partially. Eighty-five percent would "definitely recommend" the program to other patients with MBC. We observed a modest improvement in patient satisfaction with physical activities (Cohen's dz 0.33). The tailored intervention program was feasible in terms of uptake, safety, and outcomes and was highly valued by patients and physical therapists. However, disease progression interfered with the program, leading to substantial dropout. NTR register: NTR6475.